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1.
Neurodiagn J ; 60(3): 195-207, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33006508

RESUMO

Since 1995, ASET has periodically published updates to recommendations for best practices in infection prevention for Neurodiagnostic technologists. The latest installment was accepted in December 2019 for publication in Volume 60, Issue 1, before we had much knowledge or understanding about the SARS-CoV-2, the virus that causes COVID-19. This Technical Tips article is presented as an addendum to the 2020 update and includes important information about infection prevention measures specific to procedure protocols when working with patients positive or under investigation for a highly infectious disease, and when working with patients in general during the current pandemic. All Neurodiagnostic technologists who have direct patient care are responsible for ensuring the use of best practices to prevent the spread of infection.


Assuntos
Infecções por Coronavirus/prevenção & controle , Eletroencefalografia/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pessoal Técnico de Saúde , Betacoronavirus , Técnicas de Diagnóstico Neurológico/instrumentação , Desinfecção/métodos , Eletroencefalografia/instrumentação , Contaminação de Equipamentos , Humanos , Polissonografia/instrumentação , Polissonografia/métodos
2.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33008491

RESUMO

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Assuntos
Pediatria , Medicina do Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Telemedicina/métodos , Betacoronavirus , Criança , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus , Humanos , Otolaringologia , Pandemias , Pneumonia Viral , Polissonografia , Encaminhamento e Consulta , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia
3.
Curr Opin Ophthalmol ; 31(6): 508-513, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009084

RESUMO

PURPOSE OF REVIEW: The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS: OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY: OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.


Assuntos
Oftalmopatias/complicações , Apneia Obstrutiva do Sono , Biomarcadores , Ritmo Circadiano , Humanos , Polissonografia , Doenças Retinianas/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
4.
Rev Assoc Med Bras (1992) ; 66(9): 1203-1209, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027446

RESUMO

INTRODUCTION: Currently there has been significant growth in the number of patients with suspected obstructive sleep apnea (OSA) referred to sleep clinics. In this sense, screening and stratification methods of the severity of this pathology have become increasingly relevant. OBJECTIVE: To evaluate the performance of the NoSAS and STOP-Bang scores in the screening of OSA in a sleep clinic. METHODS: Prospectively, for 12 months, all patients referred by primary care physicians to our sleep unit for clinical evaluation and who underwent in-lab polysomnography (PSG), also completed the NoSAS score (Neck circumference, Obesity, Snoring, Age, Sex) and STOP-Bang (Snoring, Tiredness, Observed apnea, Pressure (high blood), BMI, Age, Neck circumference, Gender). A ROC (receiver operating characteristic) analysis was used to find the scores that simultaneously maximize sensitivity and specificity for each diagnosis. RESULTS: Of the 294 individuals included, 84% had OSA, of which 28.8% were mild, 34.8% moderate, and 36.4% were severe. USING THE NOSAS SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.770 (95% CI: 0.703-0.837), p<0.001, sensitivity of 57.5%, and specificity of 83.0% for a score of 12; 0.746 (95% CI: 0.691-0.802), p<0.001, sensitivity of 68.2% and specificity of 75.4% for a score of 13; 0.686 (95% CI: 0.622-0.749), p<0.001, sensitivity of 71.1% and specificity of 58.3% for a score of 13, respectively. USING THE STOP-BANG SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.862 (95% CI: 0.808-0.916), p<0.001, sensitivity of 68.4% and specificity of 85.1% for a score of 5; 0.813 (95% CI: 0.756-0.861), p<0.001, sensitivity of 77.3% and specificity of 66.1% for a score of 5; 0.787 (95% CI: 0.732-0.841), p<0.001, sensitivity of 70.0% and specificity of 79.9% for a score of 6, respectively. CONCLUSIONS: The ROC area was consistently high for both scores confirming the diagnostic ability of the NoSAS and STOP-Bang questionnaires for all OSA severities. Thus, our results suggest that these questionnaires may be a powerful tool for the screening and stratification of patients in the diagnosis of OSA. Overall, the diagnostic ability of the STOP-Bang was higher than the NoSAS.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Programas de Rastreamento , Polissonografia , Ronco , Inquéritos e Questionários
5.
Artigo em Chinês | MEDLINE | ID: mdl-33040505

RESUMO

Objective:The STOP-Bang(S-B) questionnaire is widely used for screening patients with OSA. However, BMI and NC cutoff value in the original S-B questionnaire is 35 kg/m²and 40cm, the BMI and NC value in the young and middle-aged female patients in China is lower than that. We aimed to establish a more appropriate modified STOP-Bang(MS-B) questionnaire. Method:A total of 523 cases with suspected OSA in the young and middle-aged female were included in this study. All patients were asked to completed the S-B, MS-B questionnaire and undergo overnight polysomnography(PSG). The BMI and NC value of the MS-B were determined by the optimal operating points of the ROC. The ability of S-B and MS-B were assessed by ROC and McNemar's test. Result:BMI=28 kg/m²and NC=36 cm as alternative cutoff is to refine S-B questionnaire. When taking apnea hypopnea index(AHI) ≥5 times/h, ≥15 times/h and ≥30 times/h as cut-offs, MS-B had higher sensitivity(88.7% vs 86.7%, 92.8% vs 87.7%, 95.0% vs 90.1%, respectively) and the area under the curve(0.74 vs 0.706, 0.734 vs 0.703, 0.739 vs 0.699, respectively) than S-B. There were significant differences in McNemar test(P<0.05). Conclusion:This study examined the clinical utility of MS-B. MS-B may improve predictive performance of S-B questionnaire in the young and middle-aged female with OSA.


Assuntos
Apneia Obstrutiva do Sono , China/epidemiologia , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários
6.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(4): 419-424, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32865362

RESUMO

OBJECTIVE: To analyze the morphological changes in the upper airway of obstructive sleep apnea syndrome (OSAS) patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical features by using cone beam CT (CBCT). METHODS: Thirty-six patients diagnosed with OSAS by polysomnography and daytime sleepiness scale and skeletal class Ⅱ malocclusion were treated with oral appliance for 4 months. The changes based on CBCT in the morphology of glossopharyngeal and palatopharyngeal before and after treatment in OSAS patients with different vertical features were compared. RESULTS: After treatment with oral appliance, the glossopharyngeal and palatopharyngeal morphologies of patients with mild OSAS showed significant changes. After treatment with oral appliance, the glossopharyngeal morphology of all patients showed significant changes (P<0.05). The palatopharyngeal morphology of patients in the lower and average groups also exhibited significant changes (P<0.05). Sagittal changes in the glossopharyngeal measurements of high-angle patients demonstrated significant difference, whereas the other measured values showed no significant difference. CONCLUSIONS: The morphological changes in the upper airway were significant in OSAS patients with lower and average vertical patterns when treated with oral appliance, but the changes in high vertical patterns were not significant.


Assuntos
Má Oclusão de Angle Classe II , Apneia Obstrutiva do Sono , Tomografia Computadorizada de Feixe Cônico , Humanos , Polissonografia
7.
Zhonghua Yi Xue Za Zhi ; 100(37): 2929-2933, 2020 Oct 13.
Artigo em Chinês | MEDLINE | ID: mdl-32993253

RESUMO

Objectives: To investigate the cognitive impairment in patients with obstructive sleep apnea (OSA), and it's relationship with sleep-related respiratory indexes. Methods: A total of 126 patients who were diagnosed with OSA and received treatment in the Sichuan Mental Health Center from March 2018 to September 2018 were selected as the OSA group, and 92 healthy volunteers with matched age, gender and education level were also recruited as the control group. All participants were assessed by polysomnography and the montreal cognitive assessment scale (MOCA). Results: (1) The total score of MOCA, visual space/executive function score, attention score, language function score and memory score in OSA group were significantly lower than those in the control group (23±4 vs 25±4, 2.0±1.7 vs 2.9±1.5, 5.4±1.0 vs 5.7±0.7, 2.7±0.6 vs 2.9±0.3, 2.6±1.4 vs 3.0±1.4, all P<0.05). The correlation analysis showed that MOCA score was in positive correlation with education level (r=0.585, P<0.001) and mean oxygen saturation (r=0.207, P=0.020). However, the MOCA score was in negative correlation with age (r=-0.564, P<0.001) and time in bed (TIB) (r=-0.205, P=0.021). There was no correlation between MOCA score and apnea-hypopnea index (AHI) (r=-0.006, P=0.949). Multiple linear regression analysis revealed that age (t=-4.133, P<0.001), education level (t=4.001, P<0.001) and mean oxygen saturation (t=2.036, P=0.044) were the major factors that contributed to the cognitive impairment of OSA patients. Conclusions: Patients with OSA have cognitive impairment. The impairment gets more obvious when more severe hypoxia occurs at night, but it's not related to AHI.


Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Humanos , Memória , Polissonografia , Sono
8.
Zhonghua Yi Xue Za Zhi ; 100(37): 2934-2939, 2020 Oct 13.
Artigo em Chinês | MEDLINE | ID: mdl-32993254

RESUMO

Objective: To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA). Methods: From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA. Results: A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m(2) vs (25±3) kg/m(2), P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143), P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143), P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143), P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (both P<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001). Conclusions: A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.


Assuntos
Cardiomiopatia Hipertrófica , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
Zhonghua Yi Xue Za Zhi ; 100(34): 2675-2681, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32921016

RESUMO

Objective: To explore the relationship between insomnia phenotype and mild cognitive impairment (MCI) in young and middle-aged patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Those patients admitted due to snoring and examined by polysomnography (PSG) in the Sleep Center of the Second Affiliated Hospital of Soochow University from January 2014 to January 2019 were screened. They were between 30 and 60 years old, and their cognitive function was assessed by the Montreal cognitive assessment (MoCA) and their sleep quality was assessed by the Pittsburgh sleep quality index (PSQI). According to the sleep apnea hypopnea index (AHI), the patients were divided into three groups: snoring group (AHI<5 times/h), mild/moderate OSAHS group (5≤AHI≤30 times/h) and severe OSAHS group (AHI>30 times/h). According to the results of PSQI score, the patients were further divided into non-insomnia group (PSQI total score<8) and insomnia group (PSQI total score≥8). The differences of parameters in different groups were compared, and the relationship between OSAHS insomnia phenotype and MCI was analyzed by binary logistic regression model. Results: A total of 2 098 patients with the average age of (42.7±8.4) years old and the average BMI of (26.3±3.6) kg/m(2) were enrolled in the study, including 398 cases in snoring group (including 254 cases in non-insomnia group and 144 cases in insomnia group), 754 cases in mild/moderate OSAHS group (including 446 cases in non-insomnia group and 308 cases in insomnia group) and 946 cases in severe OSAHS group (including 722 cases in non-insomnia group and 224 cases in insomnia group). In the mild/moderate OSAHS group, compared with the non-insomnia group, the proportion of women in the insomnia group was higher with lighter degree of obesity, lighter severity of illness and lighter degree of hypoxia (all P<0.05). In the severe OSAHS group, the general characteristics of insomnia patients were similar to those of the mild/moderate OSAHS group, and the MoCA score of the insomnia group was lower than that of the non-insomnia group [(26.3±2.7) vs (25.5±2.9) points] (P=0.001). In the evaluation of each item of PSQI, the total score and daytime dysfunction score of insomnia patients in mild/moderate OSAHS group and severe OSAHS group was higher than those in snoring group [(11.2±1.9) points, (12.8±2.2) points vs (10.9±2.1) points and (1.5±0.4) points, (1.9±0.8) points vs (0.5±0.5) points], but the score in sleep latency was lower than that in snoring group [(1.5±0.5) points, (1.5±0.5) points vs (2.1±0.8) points] (all P<0.05). After correcting the effects of OSAHS disease severity, hypoxia, awake times, education, age, gender, hypnagogue, BMI, smoking and drinking history, the risk of MCI in insomnia group of severe OSAHS patients was significantly higher than that of non-insomnia group by 49% (OR=1.49, 95%CI: 1.05-2.11). Conclusion: Insomnia phenotype is a common clinical phenotype of OSAHS, and it is a risk factor for MCI in young and middle-aged patients with severe OSAHS.


Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Fenótipo , Polissonografia
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(5): 703-707, 2020 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-32897199

RESUMO

OBJECTIVE: To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients. METHODS: A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (n=120), mild OSAS group (AHI of 5.0-14.9; n=90), moderate OSAS group (AHI of 15.0-29.9; n=113) and severe OSAS group (AHI ≥ 30; n=108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW. RESULTS: The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups (P < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group (P < 0.05 or P < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (ß=0.111, P=0.032) and RDW (ß=0.106, P=0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (P=0.0001). CONCLUSIONS: The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.


Assuntos
Índices de Eritrócitos , Apneia Obstrutiva do Sono , Idoso , Estudos Transversais , Humanos , Polissonografia , Índice de Gravidade de Doença
11.
Vestn Otorinolaringol ; 85(4): 43-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32885636

RESUMO

Clinical data of seven patients with severe obstructive sleep apnea, in whom episodes of asystole were recorded at night, is analyzed. In five of seven cases against the background of initiated CPAP therapy (all patients were compliant with the therapy), episodes of asystole were eliminated, and only two cases required the installation of a pacemaker. Conclusions are drawn about the possibility of asystole developing in the background of obstructive respiratory episodes during sleep in patients with severe OSAS and the preventive effect of CPAP therapy.


Assuntos
Parada Cardíaca , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Polissonografia
12.
Adv Clin Exp Med ; 29(9): 1065-1072, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32894824

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) may predispose patients to acute kidney injury (AKI) and chronic kidney disease (CKD). OBJECTIVES: We postulated that apneic episodes during sleep in patients with OSA may result in episodes of subclinical AKI that may be detected by the use of novel sensitive serum and urine markers. The treatment of OSA may protect against renal injury. MATERIAL AND METHODS: The study involved 86 men who had positive screening test results for OSA and estimated glomerular filtration rates (eGFR) calculated with the Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation >60 mL/min/1.73 m². All the patients underwent overnight polysomnography (the diagnostic night). The patients were divided into 2 groups: 45 patients with mild OSA and 41 patients with moderate-to-severe OSA. Those in the latter group were qualified for 6-8 weeks of continuous positive airway pressure (CPAP) treatment. Blood pressure, serum creatinine, high sensitivity C-reactive protein (hsCRP), urine creatinine, AKI markers cystatin C and neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, and endothelium marker intercellular adhesion molecule-1 (ICAM-1) were assessed in both groups before and after polysomnography. The same parameters were also measured in the patients with moderate-to-severe OSA after CPAP therapy. RESULTS: Kidney injury molecule 1 and urine NGAL significantly increased after the diagnostic night in the whole group and in mild OSA patients (p = 0.04 and p = 0.001, respectively). Serum ICAM-1 significantly decreased after the diagnostic night only in mild OSA patients (p = 0.03. Urine cystatin C increased after 6-8 weeks of CPAP treatment in the moderate-to-severe OSA group (0.003). Serum ICAM-1 decreased after the CPAP treatment (p = 0.02). The CPAP therapy led also to a decrease in mean and diastolic (p = 0.005) blood pressure. CONCLUSIONS: The pattern of overnight changes in serum and urine AKI markers after apneic episodes during sleep may suggest an increased risk of subclinical AKI in patients with OSA. The CPAP therapy is not protective against AKI, but may reduce some of its risk factors, including high blood pressure and endothelial damage.


Assuntos
Lesão Renal Aguda , Apneia Obstrutiva do Sono , Biomarcadores , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Masculino , Polissonografia
13.
Medicina (B Aires) ; 80(4): 317-323, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32841134

RESUMO

Polysomnography without real-time technical supervision (sleep test level II) h as been described with adequate quality of neurological and respiratory signals. We compare the efficiency and quality of sleep in hospitalized patients and in the sleep laboratory. The study was retrospective, in a consecutive sample of systematic collection based on PSG level II. We include 486 patients: 156 hospitalized and 330 outpatients; 94 men (60.2%) vs. 181 (55%); age: 67.5 ± 12.8 vs. 59.3 ± 14.7 years, p < 0.001; body mass index (kg/m2): 29.5 ± 6.3 vs. 29.7 ± 6.3, p: 0.8. The rate of apneas and hypopneas per sleep hour (AHI in ev/h) was: 20.8 (8.3-42.5) vs. 12.1 (4.8-26.23), p < 0.01; mild obstructive sleep apnea (OSA): 30 (19.2%) vs. 104 (31.5%) p < 0.05 and severe OSA: 62 (37.2%) vs. 64 (18.9%), p < 0.0001. The hospitalized population showed greater severity by AHI (p < 0.01). Total sleep time and mean efficiency (%) were lower in hospitalized: 231 minutes vs. 304, p < 0.0001 and 63.7 vs. 76.8, p < 0.001. A small proportion had a normal efficiency (> 80% of total sleep time), being higher in outpatients: 41.5 vs. 22.5 p < 0.001. Finally, in those with total sleep time > 3 hours, the efficiency (%) was lower in hospitalized: 73.3 (60.8-82.1) vs. 78.5 (67.1-86.2), p < 0.01. In hospitalized patients the quality and efficiency of sleep were lower with a small proportion of patients sleeping four hours during a polysomnography test.


Assuntos
Pacientes Ambulatoriais , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Sono , Apneia Obstrutiva do Sono
14.
Respiration ; 99(8): 690-694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854106

RESUMO

The attenuation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, at least in Italy, allows a gradual resumption of diagnostic and therapeutic activities for sleep respiratory disorders. The knowledge on this new disorder is growing fast, but our experience is still limited and when a physician cannot rely on evidence-based medicine, the experience of his peers can support the decision-making and operational process of reopening sleep laboratories. The aim of this paper is to focus on the safety of patients and operators accessing hospitals and the practice of diagnosing and treating sleep-related respiratory disorders. The whole process requires a careful plan, starting with a triage preceding the access to the facility, to minimize the risk of infection. Preparation of the medical record can be performed through standard questionnaires administered over the phone or by e-mail, including an assessment of the COVID-19 risk. The home sleep test should include single-patient sensors or easy-to-sanitize material. The use of nasal cannulas is discouraged in view of the risk of the virus colonizing the internal reading chamber, since no filter has been tested and certified to be used extensively for coronavirus due to its small size. The adaptation to positive airway pressure (PAP) treatment can also be performed mainly using telemedicine procedures. In the adaptation session, the mask should be new or correctly sanitized and the PAP device, without a humidifier, should be protected by an antibacterial/antiviral filter, then sanitized and reassigned after at least 4 days since SARS-CoV-2 was detected on some surfaces up to 72 h after. Identification of pressure should preferably be performed by telemedicine. The patient should be informed of the risk of spreading the disease in the family environment through droplets and how to reduce this risk. The follow-up phase can again be performed mainly by telemedicine both for problem solving and the collection of data. Public access to hospital should be minimized and granted to patients only. Constant monitoring of institutional communications will help in implementing the necessary recommendations.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Telemedicina/métodos , Filtros de Ar , Betacoronavirus , Tomada de Decisão Clínica , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Gerenciamento Clínico , Desinfecção , Medicina Baseada em Evidências , Humanos , Itália , Polissonografia/instrumentação , Pneumologia , Sociedades Médicas
15.
Medicine (Baltimore) ; 99(34): e21915, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846859

RESUMO

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 < 95%) in patients with obstructive sleep apnea (OSA) requiring deep sedation and developing an algorithm to predict OD.We studied 66 OSA patients undergoing propofol-induced deep sedation for drug-induced sleep endoscopy (DISE). The patients were divided into prediction (n = 35) and validation (n = 31) groups. Patient characteristics and polysomnographic parameters were analyzed with receiver operating characteristic curve and Chi-squared test to identify significant predictors of OD for developing an algorithm in the prediction group. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value of the algorithm were determined in the validation group.Six polysomnographic predictors of OD were identified, including Apnea-Hypopnea Index of total sleep time (AHI-TST), AHI at the stage of rapid eye movement (AHI-REM), percentage of time with oxygen saturation <90% (mO2 < 90%), average SpO2, lowest SpO2, and desaturation index. Stepwise multiple logistic regression analysis demonstrated that low average SpO2 (<95.05%) and high AHI-REM (>16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 < 95.05% and those with an average SpO2 ≥ 95.05% together with an AHI-REM > 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.


Assuntos
Algoritmos , Sedação Profunda/efeitos adversos , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , China/epidemiologia , Sedação Profunda/métodos , Endoscopia/métodos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Polissonografia/instrumentação , Valor Preditivo dos Testes , Propofol/administração & dosagem , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Sono REM
17.
PLoS One ; 15(8): e0236667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756570

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. METHODS: In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. RESULTS: Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. CONCLUSION: PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Rigidez Vascular/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia
18.
Artigo em Chinês | MEDLINE | ID: mdl-32791598

RESUMO

Objective:To explore the main influencing factors of excessive daytime sleepiness(EDS) in adults with different degrees of sleep-disordered breathing(SDB), which will provide the scientific evidences for the individualized diagnosis and treatment. Method:Retrospective analysis was performed on the clinical data of 361 young and middle-aged snoring patients monitored by polysomnography. According to the presence or absence of obstructive sleep apnea(OSA) and apnea hypopnea index(AHI) levels, they were divided into primary snoring(AHI<5), mild OSA(AHI 5-<15), moderate OSA(AHI 15-<30) and severe OSA(AHI≥30). From sleep efficiency(ES), different sleep stages(REM, NREM1, NREM2, NREM3) ratio of total sleep, oxygen reduction index(ODI), blood oxygen saturation<90% of total sleep time(TS90%), the average saturation of blood oxygen(MSaO2) and the lowest blood oxygen saturation(LSaO2) of all-night sleep, and AHI in different sleep stages(REM-AHI, NREM-AHI), MSaO2 in different sleep stages(REM-MSaO2, NREM-MSaO2) and LSaO2 in different sleep stages(REM-LSaO2, NREM-LSaO2), the main influencing factors of EDS were discussed. Result:Among the 361 patients, 23 patients suffered from the primary snoring, 47 patients with mild OSA, 56 patients with moderate OSA, and 235 patients with severe OSA. REM-AHI, ODI and TS90% in EDS group were 10.9, 9.6 and 0.2 respectively in patients with primary snoring, which were significantly higher than those without EDS(P<0.01). The main influencing factors of EDS were REM-AHI, ODI, and TS90%. However, among patients with mild OSA, REM-AHI was the main influencing factor of EDS, REM-AHI of the EDS group was 29.6, which was significantly higher than that of the non-EDS(P<0.05). In patients with moderate OSA, LSaO2 of the EDS group was 76.2, significantly lower than the group without EDS(P<0.05), the main influencing factor of EDS is LSaO2. In patients with severe OSA, BMI, ODI and TS90% in EDS group were significantly higher than those without EDS(P<0.05 or P<0.01), while NREM-MSaO2, MSaO2 and LSaO2 were significantly lower than those without EDS(P<0.05 or P<0.01). The main influencing factors of EDS were BMI, NREM-MSaO2, MSaO2, LSaO2, ODI and TS90%. Conclusion:Frequent apnea during REM stage may be one of the important factors causing EDS in patients with primary snoring and mild OSA. For patients with moderate and severe OSA, intermittent hypoxia at night may be the main factor leading to EDS, and obesity may promote the development of the disease and the occurrence of sleepiness.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Adulto , Humanos , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Ronco
19.
Artigo em Chinês | MEDLINE | ID: mdl-32791638

RESUMO

Objective:To evaluate the accuracy of the new carbon black polyurethane dry electrode electroencephalogram and clarify the value of the new dry electrode electroencephalogram. Method:Forty-three male-adult patients in the group were wearing both Ag/AgCl wet electrode and new dry electrode for sleep monitoring. The wet electrode recording was used as the gold standard for diagnostic accuracy analysis of dry electrode monitoring results. Result:The overall accuracy of the new type of dry electrode EEG was 74.53%, and the diagnostic efficiency of the dry electrode was significantly different among different stages. The sensitivity of WK, N1, N2, N3 and REM is 85.75%, 61.92%, 74.22%, 79.70% and 74.50%, and the specificity is 95.54%, 88.46%, 88.15%, 95.07%, 98.55%, respectively. Conclusion:The dry electrode EEG acquisition accuracy is good, especially for the WK, which is beneficial to improve the accuracy of the portable sleep monitoring equipment for the diagnosis of OSA disease.


Assuntos
Eletroencefalografia , Sono , Adulto , Eletrodos , Estudos de Viabilidade , Humanos , Masculino , Polissonografia , Fases do Sono
20.
Artigo em Chinês | MEDLINE | ID: mdl-32791641

RESUMO

Objective:To compare the effect of impulse-radio ultrawideband(IR-UWB) radar technology and polysomnography(PSG) in sleep assessment. Method:A total of 79 OSA patients were randomly divided into two groups: 40 patients in group A received PSG and IR-UWB, and 39 patients in group B received micromovement sensitive mattress(MSM) and IR-UWB. Pearson correlation and ROC curve were used for statistics. Result:AHI PSG and AHI MSM were significantly correlated with AHI IR-UWB(r=0.91, P=0.00; r=0.92, P=0.00). Bland-Altman analysis showed that AHI IR-UWB value was highly consistent with AHI PSG value(95.00%), and AHI IR-UWB value(97.44%). The sensitivity and specificity of AHI IR-UWB compared with PSG were 70.40% and 89.90%, respectively. The area under ROC curve was 0.915. Conclusion:IR-UWB has a high diagnostic value for adult OSA in terms of minimum blood oxygen saturation, average blood oxygen saturation, average number of central sleep apnea, average number of complex sleep apnea, average heart rate, sleep efficiency, REM sleep duration, average AHI, etc. It is an economic and practical sleep evaluation tool.


Assuntos
Minorias Sexuais e de Gênero , Apneia Obstrutiva do Sono , Adulto , Homossexualidade Masculina , Humanos , Masculino , Polissonografia , Radar , Sensibilidade e Especificidade
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